Source: PENNSYLVANIA STATE UNIVERSITY submitted to
EFFECTS OF RESIDENCE, RACE, AND INCOME INEQUALITY ON HEALTH AND MORTALITY AMONG RURAL POPULATIONS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
Reporting Frequency
Annual
Accession No.
0181853
Grant No.
(N/A)
Project No.
PEN03692
Proposal No.
(N/A)
Multistate No.
(N/A)
Program Code
(N/A)
Project Start Date
Jun 1, 1999
Project End Date
Mar 31, 2005
Grant Year
(N/A)
Project Director
Stokes, C. S.
Recipient Organization
PENNSYLVANIA STATE UNIVERSITY
208 MUELLER LABORATORY
UNIVERSITY PARK,PA 16802
Performing Department
AGRI ECONOMICS & RURAL SOCIOL
Non Technical Summary
(N/A)
Animal Health Component
25%
Research Effort Categories
Basic
75%
Applied
25%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
80360103080100%
Goals / Objectives
Examine relationships among residence, race, and income inequality and health and mortality among rural and urban counties. Estimate models of cause-specific mortality for the leading causes of death.
Project Methods
Secondary data from the Compressed Mortality File produced by the National Center for Health Statistics will be combined with decennial census data, the Area Resource File data and data from the Hospital Services Administration to estimate total and cause-specific mortality in relation to community socioeconomic characteristics and health service availability. Geographic clustering of mortality will be examined for spatial autocorrelation.

Progress 06/01/99 to 03/31/05

Outputs
The project documents the importance of income inequality as a correlate of county-level mortality rates. However, the influence of income inequality on mortality is mediated when measures of socioeconomic status and rurality are included in weighted least squares and spatially adjusted models. One possibility is that factors associated with high and low mortality are clustered together in places and controlling for their spatial proximity may reduce their influence in the models. Findings suggest that ecological models that estimate spatial relationships across geographic places are important in the development of regional and/or local policies and programs to improve health and lower mortality.

Impacts
Polices to address structural disadvantages characterizing many minority communities, reducing violent crime, the number of superfund sites, and the unemployment rate in counties would appear to lower mortality rates.

Publications

  • McLaughlin, D., Stokes, C. S., Smith, P.J. and Nonoyama, A. 2006 (accepted for publication). Differential mortality in the U.S.: The influence of local inequality. In L. Lobao, G. Hooks, and A. Tickamye (eds.), Spaces, Places, and Inequality: The Sociology of Spatial Inequality. State University of New York Press.
  • Sambisa, W. and Stokes, C.S. 2006 (accepted for publication). Rural/urban residence, migration, HIV/AIDS and safe sex practices in Zimbabwe. Rural Sociology.


Progress 01/01/04 to 12/31/04

Outputs
Mortality data for U.S. counties were updated to 2000 and new models incorporating income inequality, socioeconomic status, urbanicity/rurality, social conditions and safety, health care availability and environmental risks were estimated. Areas with higher socioeconomic status had significantly lower mortality regardless of the presence of other factors. Counties with greater numbers of rent-seeking organizations and higher levels of structural disadvantage tended to exhibit higher mortality. Rural males in Zimbabwe were found to be less knowledgeable about ways to prevent HIV/AIDS and less likely uses practices to reduce the risk of contracting the virus.

Impacts
Policies to address structural disadvantages characterizing many minority communities, reducing violent crime, the number of superfund sites, and the unemployment rate in counties would appear to lower mortality rates.

Publications

  • Eloundou-Enyegue, P. M. and Stokes, C.S. 2004. Teen fertility and gender inequality in education: A contextual hypothesis. Demographic Research. Accepted for publication.


Progress 01/01/03 to 12/31/03

Outputs
We find substantial spatial variation and spatial clustering of mortality across counties in the United States. The inequality gradient, however, is reduced substantially when controls for educational attainment, occupational structure and demographic composition are introduced. Minimal change in the gradient was found with controls for social conditions, health care availability and environmental risks. Participation rates in the Temporary Assistance to Needy Families program in Mississippi varied with the economic and social conditions in local communities. Indicators were developed to measure the impacts of HIV/AIDS on rural livelihoods and food security in development countries.

Impacts
Research continues to demonstrate the importance of local conditions on the health and mortality of populations. Once the mechanisms through which these conditions operate are identified, health care policies and programs can be designed to ameliorate their impacts.

Publications

  • Parisi, D., McLaughlin, D.K., Grice, S.M., Taquino, M, and Gill, D.A. 2003. TANF participation rates: Do community conditions matter. Rural Sociology. 68:491-512.
  • Stokes, C. S. 2003. Measuring impacts of HIV/AIDS on rural livelihoods and food security. Rome, Italy: Food and Agriculture Organization of the United Nations. 40 pp. http://www.fao.org/sd/2003/PE0102a_en.htm
  • Nonoyama, A. 2003. The effects of unwanted pregnancy and mother's education on infant mortality in Bangladesh. Ph.D. Dissertation. The Pennsylvania State University, University Park, PA. 154 pp.
  • Chen, J. 2003. Contraceptive use and method choice in China. M.S. Thesis. The Pennsylvania State University, University Park, PA. 94 pp.


Progress 01/01/02 to 12/31/02

Outputs
The relationship between income inequality and mortality among all counties in the contiguous United States was examined to ascertain whether the relationship found for states and metropolitan areas extend to smaller geographic units. In addition, the influence of minority racial concentration was examined in terms of the inequality-mortality linkage. Higher income inequality at the county level was significantly associated with higher total mortality. Higher minority racial concentration also was significantly related to higher mortality and interacted with income inequality. The relationship between income inequality and mortality was demonstrated to be robust for counties in the United States. Minority concentration interacts with income inequality, resulting in higher mortality in counties with low inequality and a high percentage of Blacks, than in counties with high inequality and a high percentage of Blacks.

Impacts
Income inequality exerts a significant impact on mortality across all counties in the United States. The differential impacts of inequality on counties with high and low concentrations of minorities suggest that local conditions affecting access to health care resources and to health-promoting behaviors differ between the Black and White populations. Alternative strategies may need to be employed to improve the health status of these population groups.

Publications

  • McLaughlin, D. K., and Stokes, C. S. 2002. Income inequality and mortality in US counties: Does minority racial composition matter. American Journal of Public Health. 92:99-104.
  • Eloundou-Enyegue, P. M. and Stokes, C. S. 2002. Will economic crises in Africa weaken rural-urban ties. Insights from child fosterage trends in Cameroon. Rural Sociology. 67:278-298.
  • Ssengonzi, R., DeJong, G. F. and Stokes, C. S. 2002. The effect of female migration on infant and child survival in Uganda. Population Research and Policy Review. 21:403-431.


Progress 01/01/01 to 12/31/01

Outputs
We extended the analyses of the relationship between income inequality and mortality to include different aspects of inequality. Adjusting the multivariate models for spatial autocorrelation, we find that introducing demographic characteristics that are highly correlated with income inequality, cuts in half the increase in mortality with a rise in income inequality. The addition of measures of social conditions and safety, health care availability and housing quality, and environmental risk did not substantially reduce the relationship between income inequality and total mortality. Separate analyses of mortality for Blacks and Whites showed substantial variation in the factors that affect Black mortality rates and White mortality rates. In particular, higher levels of income inequality had a larger positive effect on Black mortality than on white mortality, and the gradient in mortality was more stark for Blacks. Blacks seem to be particularly disadvantaged in high inequality counties, even when health care availability, environmental risks, and other demographic characteristics are included in the models. We further examined whether there were differences in the ways that income inequality, demographic characteristics, social conditions and physical safety, health services, and environmental risks influence age-sex-race adjusted total mortality rates in metropolitan and nonmetropolitan counties. While there was a slight difference in the relationship between income inequality and mortality in metro and nonmetro counties, there were statistically different effects for many of the other variables included in the models. These differences occurred across the variable groups in the model, but there were substantively large differences, with a nonmetro disadvantage, for living in the South, violent crime, and having a Superfund site in the county.

Impacts
Factors affecting race-specific mortality rates, and total mortality in metro and nonmetro counties clearly differ. Aspects of demographic characteristics of residents, social conditions and physical safety, health service availability, and environmental risks each differ in influencing mortality rates, as does income inequality. These findings suggest that strategies to lower mortality in high mortality areas need to consider the local conditions and behaviors of residents. Further, there must be recognition that these local conditions may have different effects on Black residents and White residents, and that they differ in metro and nonmetro counties.

Publications

  • McLaughlin, D. K., Stokes, C. S. and Nonoyama, A. 2001. Residence and income inequality: effects on mortality among U.S. counties. Rural Sociology 66:579-598.
  • Vicary, J. R., Snyder, A. R. and Henry, K. L. 2000. The effects of family variables and personal competencies on the initiation of alcohol use by rural seventh grade students. Adolescent & Family Health 1:21-28.


Progress 01/01/00 to 12/31/00

Outputs
Analyses focused on the additive and interaction effects of race and income inequality on mortality among U.S. counties. Nonmetro counties were found to have lower mortality than metropolitan counties once rates were adjusted for age, sex, and race. Moreover, income inequality had stronger impacts in nonmetro counties and this effect persists with per capita income, household size, and racial composition controlled. The percentage of the population that is Black exerts an independent effect on mortality in both metro and nonmetro counties. In addition, minority concentration interacts with income inequality resulting in higher mortality in counties with low inequality and higher percentage Black than in counties with high inequality and high percentage Black.

Impacts
Concentrations of racial minorities and income inequality are associated with higher mortality in U. S. counties regardless of other factors considered. These findings suggest that aspects of community organization influence mortality. Thus, additions to life expectancy in the U. S. will require attention to selected aspects of social organization, in addition to improving health care and individual behavioral patterns.

Publications

  • Eloundou-Enyegue, P. M., Stokes, C. S. and Cornwell., G. T. 2000. Are there crisis led fertility declines. Evidence from central Cameroon. Population research and policy review. 19:47-72.
  • Ssengonzi, R. 2000. Female migration and infant/child survival in Uganda. Ph.D. Thesis. The Pennsylvania State University, University Park, PA. 173 pp.
  • Gajurel, K. 2000. Organization of agricultural production and human fertility. Ph.D. Thesis. The Pennsylvania State University, University Park, PA. 160 pp.


Progress 01/01/99 to 12/31/99

Outputs
A working data set based on county-level data from the Compressed Mortality File with information on all deaths from 1968-1992 by age, race, sex, cause, and county of residence was constructed and linked to sociodemographic information from the U.S. Census and other sources for all 3,000+ counties in the United States. Age-adjusted death rates have been calculated for all coterminous counties in the U.S. Preliminary findings show that regardless of the measure of income inequality used, higher levels of income inequality are positively and significantly related to higher mortality. Mortality from all causes was found to be more strongly related to income inequality than was infant mortality. Somewhat surprisingly, inequality in the income distribution was more strongly related to mortality than was the absolute level of income. The findings differ between metropolitan and nonmetropolitan counties suggesting that disaggregation of rates by residence is merited.

Impacts
This project began in June of 1999, thus impacts necessarily await the outcome of the research. Nonetheless, preliminary analyses suggest that socioeconomic inequalities have an important effect on county mortality rates in both urban and rural America. If these findings hold up under further investigation, they suggest that alternatives to traditional health care policy will be needed to reduce mortality.

Publications

  • No publications reported this period